Department of Plastic Surgery and Burns, Hospital del Trabajador, Santiago, Chile.
Department of Plastic Surgery, Clinica Las Condes, Santiago, Chile.
J Reconstr Microsurg. 2021 Jan;37(1):59-66. doi: 10.1055/s-0039-3402032. Epub 2020 Feb 23.
The versatile application of local perforator flaps for coverage throughout the lower extremity has already been well proven. Often a "free-style" approach has been used to design these flaps, as conventional imaging devices for perforator identification may be too expensive or unavailable. The recent adaptation of Smartphone thermal digital imaging may now prove to be a cheaper and more readily available means for identifying the requisite perforators that will sustain these local flaps.
Over the past year, a prospective study was undertaken of all patients having a local perforator flap for coverage of a lower extremity defect. Twenty-eight local perforator flaps involving all subtypes were utilized in 25 patients. Smartphone thermography was used in all patients preoperatively to identify preferable perforator or vascular network "hot spots" that allowed appropriate flap design. Intraoperative and postoperative monitoring was similarly done for all flaps to determine outcomes.
All local perforator flaps were based on perforators identified using smartphone thermography. All flaps (23 or 82.1%) that the thermal digital image predicted 100% viability totally survived. Five flaps were predicted to have marginal viability, but two nevertheless survived completely while the others required only minor readjustments. Peninsular and keystone variety perforator flaps were those most commonly used.Thermography always facilitated making the correct decision as to whether a proximal- or distal-based peninsular flap would be superior. Subfascial elevation of cool spots in keystone flaps were found to be least likely to interfere with flap perfusion.
Smartphone thermography is an inexpensive and expeditious means for identification of "hot spots" that is always used by us to ensure perfusion to lower extremity perforator local flaps. This is a complementary technique for their safer design, harvest, and subsequent monitoring in conjunction with more complex screening tools as indicated.
局部穿支皮瓣在下肢的广泛应用已经得到充分证明。通常采用“自由式”方法来设计这些皮瓣，因为传统的穿支识别成像设备可能过于昂贵或无法获得。最近，智能手机热数字成像的应用可能成为一种更便宜、更容易获得的手段，可以识别维持这些局部皮瓣所需的穿支。
在过去的一年中，我们对所有接受局部穿支皮瓣覆盖下肢缺损的患者进行了前瞻性研究。25 名患者共使用了 28 个涉及所有亚型的局部穿支皮瓣。所有患者均在术前使用智能手机热成像来识别合适的穿支或血管网络“热点”，以便进行适当的皮瓣设计。同样对所有皮瓣进行术中及术后监测，以确定结果。
所有局部穿支皮瓣均基于使用智能手机热成像识别的穿支。所有皮瓣（23 个或 82.1%）的热数字图像预测 100%存活完全存活。有 5 个皮瓣预测为边缘存活，但其中 2 个完全存活，而其他 3 个只需进行轻微调整。半岛和关键型穿支皮瓣是最常用的类型。热成像总是有助于做出正确的决策，即选择基于近端还是远端的半岛皮瓣更优。在关键型皮瓣中，发现亚筋膜下的冷点抬高最不可能干扰皮瓣灌注。
智能手机热成像术是一种经济、快捷的识别“热点”的方法，我们始终使用它来确保下肢穿支皮瓣的灌注。这是一种安全设计、采集和后续监测的补充技术，结合更复杂的筛查工具，根据需要使用。
